Understanding medical claims billing

Medical Claims
Billing is the process of submitting medical insurance claims to the proper insurance carrier.
It is important to understand all aspects of medical
claims billing in order to make sure you are bringing in all the money that is due to the provider.

Many insurance companies, especially the
larger ones, not only prefer claims to be submitted to them electronically, but
they are trying to mandate it. For example, in New York,
Medicare requires you to get an exemption form if you are still
filing your claims on paper and is now even denying secondary claims billed
on paper by larger providers.

If the insurance company does not mandate that the claims be submitted
electronically, they offer many great incentives for doing so. In most
cases, the incentive is quicker payment of insurance claims. This usually
works for most providers.
It does for the doctors that I work
with! They want their payment ASAP! Electronic claims are usually paid in
half the time that paper claims are paid in.

Click here for more information on billing your claims
electronically. Of course there will always be
situations in which it is necessary to file the insurance claim on paper. Many secondary claims must
still go on paper in order to attach a copy of the primary insurance
companys EOB (Explanation of Benefits Statement). Or you may have other
attachments that must accompany the claim such as treatment notes, or an
operative report.

Then there
are
those smaller insurance companies that are still not able to accept
electronic insurance claims. In these cases you will most likely use
HCFA
1500 forms.

If you are considered an institution you will most likely be required to
file your claims on a